Maternal-Fetal Compatibility in Recurrent Pregnancy Loss

Area of Science:

• Reproductive Immunology
• Immunogenetics
• Maternal-Fetal Medicine

Background:

• Recurrent pregnancy loss (RPL) affects many reproductive-aged patients.
• Immune cell populations and molecules are implicated in RPL pathogenesis.
• Uterine Natural Killer cells (uNKs) play a crucial role in pregnancy success.

Purpose of the Study:

• To review the role of uNKs in pregnancy.
• To discuss KIR-HLA-C polymorphisms and their clinical implications in RPL.
• To explore the involvement of other HLA molecules in RPL and management strategies for immunological mismatch.

Main Methods:

• Literature review focusing on immunological factors in RPL.
• Analysis of studies on uNKs, KIRs, and HLA-C interactions.
• Synthesis of current knowledge on HLA associations and clinical management.

Main Results:

• uNKs are vital for uterine spiral artery remodeling and trophoblast invasion control.
• Polymorphisms in Killer Immunoglobulin-like Receptors (KIRs) and Human Leukocyte Antigen-C (HLA-C) are associated with increased RPL risk.
• Other HLA molecules also contribute to RPL, necessitating comprehensive assessment.

Conclusions:

• The interaction between maternal uNKs and fetal HLA-C molecules is critical for successful pregnancy.
• Specific KIR-HLA-C combinations represent a risk factor for RPL.
• Understanding maternal-fetal immune compatibility is key for managing RPL patients.